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All inhaled anesthetic agents are potent greenhouse gases, and nitrous oxide (N2O) is additionally noxious to the ozone layer; thus they pose a threat to the environment when released into the atmosphere. Waste anesthetic gases (WAG) persist in the atmosphere anywhere from 1.1 years (sevoflurane) to 114 years (N2O).1 Methods for recapture and destruction are necessary to prevent environmental contamination. N2O is a plentiful, cheap, unstable compound and reuse is not a practical option, while destruction is possible. Halogenated agents, however, are expensive and stable compounds, and reclamation of these agents for potential re-purification and reuse, or their destruction, are both possible. Waste reduction can be achieved by newer carbon dioxide (CO2) absorber technologies that permit lower fresh gas flows without producing compound A. Prevention of WAG release to the environment should be pursued.

All well and nice, except for one thing: no clinician seems to really care what happens "beyond the O.R. wall." Despite the fact that low flow anesthesia (LFA) in closed circuit (CCA) is a simple and extremely effective way to reduce WAG almost completely, many clinicians are still reluctant to reduce flows. They are even terrorized when they see me working with metabolic flows, that is using only O2 as carrier gas and matching the flow exactly to the patient's consumption, plus leaks. Modern anesthesia workstations even show you exactly how much gas (in ml fluid) you used. It's very easy to compare the LFA CCA technique with the "let it flow" one, usually 1.5 2 liters/minute (LPM), sometimes even more. It is puzzling, though, to read that the issue of compound A and SEV not less than 2 is still reminded at all. It so happens that I have those LiOH CO2 scrubbers, basically "space technology in the O.R.," but no one was curious enough to test them on a regular basis. Pity. Truth is that, by the end of the day, many clinicians presently do not seem to care at all about waste. Strange hospital policies about infection prevention, overbuying policies that seem to be disconnected from real needs, bring costs to enormous amounts as well as producing piles of unused material. This late aspect is so widespread that one former nurse (an article that appeared last year) built a whole warehouse to collect unused but overdue equipment and send it to poor and/or conflict regions. That lady herself could not believe the extent of the hospital's waste. Does anybody care? If yes, write me at paulzi60@yahoo.com.